降血压在治疗高血压鼻出血中的作用

鼻出血是耳鼻喉科常见病,其发病原因很多,既可由鼻腔局部因素引起,也可由全身系统病变导致,其中高血压是常见的全身性疾病,因高血压患者血管收缩,血管壁的脆性增加,更易引起出血,本研究中回顾性分析了我科2001年7月至2005年11月收治的鼻出血患者中伴有原发性高血压的47例的临床资料,报告如下。     

颈部坏死性筋膜炎6例

目的：提高临床医师对颈部坏死性筋膜炎的认识。方法：回顾分析6例颈部坏死 性筋膜炎患者的临床资料及治疗结果。结果：6例患者经手术及药物治疗,5例治愈,1例因并发脓毒血症导致多器官功能衰竭死亡。结论：颈部坏死性筋膜炎 是一种进展迅速、病情凶险的感染性疾病,治疗上以尽早彻底清创、应用广谱抗菌素及支持治疗为主,增加对该病的认识有利于早期诊断,并有利于提高颈部坏死性筋膜炎的疗效。     

保留支架的鼻中隔成形术

目的：探讨鼻中隔手术中鼻中隔支架保留的方法。方法：根据鼻中隔偏曲的不同类型,设计A、B、C三种术式在显微镜下对不同的患者行保留鼻中隔支架的鼻中隔成形术。结果：手术时间缩短,术中出血减少,鼻中隔成形术后随访1～6个月,全部患者疗效满意且无并发症发生。结论：鼻中隔成形术可保留较完整的鼻中隔支架,具有创伤小、出血少及术时短的优点,是一种微创手术的新方法。     

心肺联合超声检测COVID-19心血管系统损伤

基础和临床研究已经证实,新型冠状病毒肺炎(COVID-19)不仅会造成患者呼吸系统的严重病变,同时也对心血管系统产生不同程度的损伤.这些损伤通常同时具有炎症和非炎症损伤的特点,部分患者临床表现与疾病严重程度并不平行,病情变化急剧.充分采用简便、可靠的心肺联合超声检测技术方法,既有助于COVID-19患者的分型、分类管理...     

Self-adaptive integration of photothermal and radiative cooling for continuous energy harvesting from the sun and outer space

The sun (∼6,000 K) and outer space (∼3 K) are two significant renewable thermodynamic resources for human beings on Earth. The solar thermal conversion by photothermal (PT) and harvesting the coldness of outer space by radiative cooling (RC) have already attracted tremendous interest. However, most of the PT and RC approaches are static and monofunctional, which can only provide heating or cooling respectively under sunlight or darkness. Herein, a spectrally self-adaptive absorber/emitter (SSA/E) with strong solar absorption and switchable emissivity within the atmospheric window (i.e., 8 to 13 μm) was developed for the dynamic combination of PT and RC, corresponding to continuously efficient energy harvesting from the sun and rejecting energy to the universe. The as-fabricated SSA/E not only can be heated to ∼170 °C above ambient temperature under sunshine but also be cooled to 20 °C below ambient temperature, and thermal modeling captures the high energy harvesting efficiency of the SSA/E, enabling new technological capabilities.

Heating and cooling are two kinds of significant end uses of thermal energy in society, which exist in various conditions (e.g., space/water heating, space cooling, and industrial processes) and account for 51% of the total final energy consumption (1). For example, the heating and cooling of buildings are responsible for nearly 48% of the building energy consumption, increasing to be the largest individual energy expense (2). Therefore, heat and cool harvesting relying on clean techniques from renewable energy resources has drawn remarkable attention from fields of engineering to material science because it has considerable potential for global energy conservation and greenhouse emission reduction. Thermodynamically, any heat transportation and work-generation process requires a temperature gradient. The hot sun (∼6,000 K) and cold outer space (∼3 K) are the ultimate heat source and heat sink for the Earth. Theoretical analysis reveals that maximal output work can be extracted from nonreciprocal systems based on the temperature difference between the sun and Earth (∼300 K) with an ultimate solar energy harvesting efficiency limit of 93.3%, while a maximal work of 153.1 W·m⁻² can also be obtained on the basis of temperature difference between the Earth and outer space (3, 4). Thus, the sun and outer space are two significant renewable thermodynamic resources for the Earth, which can be effectively utilized for clean heat and cool collection.Photothermal (PT) is a widely used solar thermal collection method that employs solar absorbers to capture solar photons and convert them to heat. Thermal analysis reveals that a good candidate for a solar absorber should have high solar absorptivity and low thermal emissivity simultaneously for efficient solar thermal collection. Various materials, including multilayer metal/ceramic films (5, 6), photonic crystals (7, 8), and metamaterials (9, 10), have been developed for spectrally selective solar absorbers and have been used for real-world applications. Meanwhile, radiative cooling (RC) has re-elicited considerable interest in recent years because it can passively provide clean cooling without any extra energy input (11–14). The waste heat of terrestrial objects can be continuously pumped into the cold outer space, relying on the transparent atmospheric window (i.e., 8 to 13 μm). So, high emissivity within the atmospheric window of materials is necessary for efficient RC, and excellent solar reflection is also important for RC under sunshine. Thus, different materials with the tailored spectrum, such as photonic structures (15–17), structure materials (18), energy-saving paints (19–21), and even metamaterials (22–24), have been reported for passive cooling. On the potential application level, RC implementations also span a range of fields, including passive cooling of buildings (25–27), thermal management of textiles and color surfaces (28–30), atmospheric water harvesting (31), and thermoelectric generation (32, 33). Although the reported PT and RC can generate heat and cold with high efficiency through different spectrally selective materials, most of the approaches are static and monofunctional, which can only provide heating or cooling under sunlight or darkness. Therefore, the dynamical integration of PT and RC for continuously efficient heat and cool harvesting is a new topic for the energy exploitation of the sun and outer space. The tunable combination of PT and RC hybrid utilization has been recently proposed, but mechanical methods such as switching (e.g., flip action) a PT absorber and an RC emitter manually (34) or changing the optical properties of the materials through extra force stimuli (35) are preferred.Herein, a smart strategy for the dynamic combination of daytime PT and nighttime RC is proposed, corresponding to continuously efficient energy harvesting from the sun and rejecting energy to the universe. A spectrally self-adaptive absorber/emitter (SSA/E) with solar absorption of over 0.8 and emissivity modulation capability of regulating from broadband emissivity of 0.25 within the mid-infrared (MIR) region to the selective high emissivity of 0.75 within the atmospheric window is designed and fabricated for the proof of the concept. Outdoor thermal experimental results demonstrate that the SSA/E can be heated to ∼170 °C above ambient temperature in the daytime PT mode and passively cooled to ∼20 °C below ambient temperature in the nighttime RC mode. Moreover, the heat and cool energy gains of the SSA/E system are respectively predicted to be 78% and 103% larger than those of the reference system that combines static and monofunctional PT absorber and RC emitter.     

孟河医派特色炮制猪心血拌丹参及其他炮制品活性成分与抗脑缺血氧化损伤相关性分析

目的 分析猪心血拌丹参及其他丹参炮制品中11个小分子活性成分及1个蛋白成分与抗脑缺血氧化损伤的相关性,明确猪心血拌丹参抗脑缺血氧化损伤的关键成分标志物。方法 采用高效液相色谱法（HPLC）同时测定丹参、猪心血拌丹参、猪血拌丹参、酒拌丹参、猪血清转铁蛋白（Tf）拌丹参5种饮片中11种活性成分含量;采用酶联免疫吸附测定法（ELISA）检测丹参不同炮制品中Tf的含量。构建斑马鱼缺血性脑卒中模型,考察丹参不同炮制品对脑缺血斑马鱼行为轨迹、转基因斑马鱼Tg（elavl3：eGFP）脑神经元损伤及脑组织中丙二醛（MDA）和超氧化物歧化酶（SOD）水平的影响;构建糖氧剥夺/复氧（OGD/R）诱导的小鼠海马神经细胞缺血缺氧模型,以乳酸脱氢酶（LDH）、活性氧（ROS）、MDA和SOD为评价指标,考察丹参不同炮制品对神经细胞氧化损伤的影响;通过主成分分析（PCA）、偏最小二乘判别法-判别分析（PLS-DA）及Spearman相关性分析对11个小分子活性成分及1个蛋白成分与药效指标进行分析,筛选猪心血拌丹参抗脑缺血氧化损伤的关键成分标志物。结果 与丹参比较,丹参各炮制品中水溶性、脂溶性成分含量均呈不同程度的升高,而丹酚酸A成分含量降低;与酒拌丹参比较,猪心血拌丹参、猪血拌丹参及Tf拌丹参中丹酚酸B、丹参素、迷迭香酸等成分含量均升高,而丹酚酸A含量降低。ELISA结果显示,猪心血拌丹参、猪血拌丹参及Tf拌丹参中均含有Tf蛋白,且三者含量差异无统计学意义。药效结果显示,丹参不同炮制品均能改善斑马鱼缺血性脑卒中后出现的行为缺陷、脑神经元损伤及氧化应激,且猪心血拌丹参组作用最明显。PCA结果显示,丹酚酸B、丹酚酸A、迷迭香酸、紫草酸、丹参素、咖啡酸、丹参酮Ⅱ_A、隐丹参酮、丹参酮Ⅰ为丹参及其炮制品中的主要贡献成分。相关性分析结果显示,隐丹参酮、迷迭香酸、咖啡酸、二氢丹参酮Ⅰ、丹酚酸B、丹参酮Ⅱ_A、丹参酮Ⅰ与斑马鱼脑组织中MDA水平呈负相关,紫草酸、原儿茶醛、迷迭香酸、二氢丹参酮Ⅰ、丹酚酸B、Tf与SOD水平呈正相关,迷迭香酸、咖啡酸、二氢丹参酮Ⅰ、丹酚酸B、丹参酮Ⅱ_A、丹参酮Ⅰ、丹参素、Tf与斑马鱼脑神经元荧光强度呈正相关;紫草酸、原儿茶醛、迷迭香酸、二氢丹参酮Ⅰ、丹酚酸B、丹参素、Tf与HT22细胞中LDH、ROS、MDA水平呈负相关,与SOD水平呈正相关。结论 丹参及其不同炮制品抗脑缺血氧化损伤作用存在差异,其中以猪心血拌丹参改善氧化损伤作用最强,这可能与丹酚酸B、丹参素、迷迭香酸等成分的含量变化有关,可为明确该孟河医派特色炮制品抗脑缺血质量标志物及阐明其炮制机制提供依据。     

基于Box-Behnken响应面设计优选中药复方便乃通的提取工艺

[目的] 利用Box-Behnken响应面设计法优化中药复方便乃通（BNT）的提取工艺。[方法] 基于单因素实验优选BNT提取工艺的影响因素及其范围,运用Box-Behnken响应面设计法构建三因素三水平实验设计方案,以番泻苷B、番泻苷A及橙皮苷的含量作为响应指标优选最佳提取工艺条件,并进行工艺验证。[结果] 中药复方BNT的最佳提取工艺条件为料液比1∶8,回流时间30 min,提取次数2次。[结论] 利用Box-Behnken响应面设计法优化中药复方BNT提取工艺方法稳定,可为BNT提取工艺提供参考。     

佛手乙酸乙酯提取液对哮喘模型小鼠的抗炎作用

目的 探讨佛手乙酸乙酯提取液(ethyl acetate extract from bergamo)对哮喘模型小鼠的抗炎作用.方法 采用卵白蛋白(OVA)腹腔注射致敏和雾化激发的方法 建立小鼠哮喘模型,用佛手乙酸乙酯提取液(10 g/kg)对哮喘小鼠进行干预,并以地塞米松作为阳性对照.比较观察各组小鼠外周血白细胞总数及分类计数,同时观察肺组织的病理改变.结果 佛手乙酸乙酯提取液组和地塞米松组的外周血白细胞总数、嗜酸性粒细胞、淋巴细胞均显著低于哮喘模型组(P＜0.05或P＜0.01),而地塞米松组、佛手乙酸乙酯提取液组间上述指标无显著性差异(P＞0.05).病理改变:哮喘模型组小鼠肺组织可见支气管及伴行血管周围有大量炎性细胞(嗜酸性粒细胞、浆细胞、淋巴细胞等)浸润,肺间质及肺泡腔也可见炎性细胞浸润,气道上皮可见粘液分泌;而佛手乙酸乙酯提取液组和地塞米松组肺组织中炎性细胞浸润明显减少,气道上皮未见粘液分泌.结论 佛手乙酸乙酯提取液能抑制哮喘模型小鼠嗜酸性粒细胞性炎症反应.     

增龄对牙周细胞覆盖体外创面的影响

目的:以长期培养的牙周膜和牙龈成纤维细胞模拟老化细胞,在体外创面模型中,就增龄对牙周细胞覆盖创面的影响进行评价。方法:以反复传代12代以上的牙周膜、牙龈成纤维细胞作为老化(实验组)细胞,5代以内的牙周膜、牙龈成纤维细胞作为正常对照组。4种细胞接种于盖玻片直至融合。机械方法刮除部分融合细胞,形成宽约7mm的无细胞条带,即体外创面。创面形成后继续培养2、6、9d,固定玻片并作结晶紫染色。以计算机辅助图像分析系统对细胞覆盖体外创面的面积进行百分比定量,采用SAS6.12软件包进行样本均数的t检验。结果:实验组与对照组比较,实验组的牙周膜、牙龈成纤维细胞覆盖创面面积明显较少,创面形成第6、9d,其覆盖创面面积显著低于对照组,差异有显著性(P<0.05)。实验组与对照组牙周膜、牙龈成纤维细胞覆盖创面面积存在差异,对照组创面形成后第9d牙龈成纤维细胞覆盖创面面积显著高于牙周膜细胞,差异有显著性(P<0.05)。结论:老化牙周膜、牙龈成纤维细胞覆盖创面的能力弱于正常细胞。增龄可能损害牙周细胞对创面的覆盖能力。     

叙事医学在新生儿医学人文教育方面的应用

叙事医学是人文医学发展到一定程度的结果,体现了叙事思想在医学实践中的应用。目前国内外研究已经证实,叙事医学不仅在提高医务人员共情能力、自我反思引发、职业认同感增强等方面有良好的治疗效果,对间接改善患者生理、心理等也有很多益处。新生儿医学在我国起步较晚,目前我国的新生儿重症监护室（NICU）需要隔离监护,几乎不能做到母婴同室,甚至无法探视。新生儿科工作压力大,知识更新快,医学生需要在尽快掌握临床技术的前提下加强人文素养。扎实的临床基础是每一个新生儿科医生必备的,医学的发展也要求新生儿科医生在临床工作中的每个环节融入人文关怀精神。通过叙事医学教育,使新生儿科医生主动养成善于倾听患儿以及其背后家庭的故事,理解和同情患儿及其家属的心情及抉择,形成对患儿的共情能力以及专业的职业精神,促成以患儿为中心的临床思维。叙事医学在新生儿医学人文教育方面的研究还需在今后的临床实践中继续推进、不断应用和总结。